Provider Demographics
NPI:1407636418
Name:DIONNE, JENIFER (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:
Last Name:DIONNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25115 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1183
Mailing Address - Country:US
Mailing Address - Phone:734-344-1336
Mailing Address - Fax:
Practice Address - Street 1:25115 BALSAM DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-1183
Practice Address - Country:US
Practice Address - Phone:734-344-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily